Postoperative delirium may speed the rate of cognitive decline in older adults by 40%, a new study has found.
Delirium is the most frequent postoperative complication in older adults, the researchers noted. It is characterized by “sudden, fluctuating and usually reversible disturbance of mental status with a degree of inattention,” according to the National Institutes of Health. It can occur between 10 minutes after anesthesia is given up through hospital discharge, and risk is higher in older rather than younger adults.
Decline similar to Alzheimer’s
Investigators tracked cognitive performance data for six years in 560 adults aged 70 years and older who underwent major elective surgery. They found that 24% (134) of participants developed postoperative delirium, which was associated with a 40% acceleration in cognitive decline up to six years following surgery. The speed of decline over time was similar to that seen in people who receive a diagnosis of Alzheimer’s disease within five years, they noted.
The study did not determine whether delirium contributed to these relatively rapid changes or whether preexisting brain disease put participants at higher risk for delirium, according to Sharon K. Inouye, MD, MPH, of Beth Israel Deaconess Medical Center and Harvard Medical School.
In either case, available measures should be taken to help prevent the condition from occurring in older patients, they said.
“[D]elirium represents an important and potentially preventable target for public health intervention to preserve brain health for older adults,” Inouye and colleagues wrote. “[T]he current study’s results support this perspective, heightening the potential importance of delirium prevention in older adults who are undergoing elective surgery.”
Interventions
Along with age, factors that increase the risk of delirium after surgery include decreased cognitive functioning, frailty, poor nutrition, alcohol-use disorder, depression and health comorbidities, according to an article published by the American Medical Association.
Interventions before scheduled surgery may include “a risk assessment, avoiding high-risk medications or using a geriatrician in the care team,” the AMA article states. “Physicians should be evaluating patients with hypertension, glycemia or depression to see if they need additional treatment or counseling.”
Participants were enrolled in the ongoing Successful Aging after Elective Surgery study. The study was published in JAMA Internal Medicine.
Related articles:
Delirium leads to 1-year jump in healthcare costs for post-acute Alzheimer’s patients
Delirium present in 60 percent of residents’ acute illnesses, but tricky to diagnose: study
Geriatrician endorses creative steps to reduce delirium due to COVID
What emergency docs see: Delirium signals COVID in older patients
Delirium a stand-out coronavirus symptom in people with dementia
